Panel recommends state reject Medicaid copays, premiums

A panel appointed by the New Mexico Human Services Department voted Thursday against imposing copays or premiums on low-income patients who receive Medicaid.

Meeting at the state Capitol, the committee voted down the proposal to recommend the department impose premium payments for Medicaid enrollees with an income between 125 percent and 138 percent of the federal poverty level. New Mexicans within 138 percent of the federal poverty level — an annual income of $16,404 for a household of one — or below are eligible for Medicaid.

Abuko Estrada, staff attorney for the New Mexico Center on Law and Poverty, urged a Human Services Department-appointed panel to vote against premiums and co-pays for Medicaid enrollees because of a lack of data about the potential impact. He said the department should look for other ways to find Medicaid savings beyond cutting the benefits package. Luis Sánchez Saturno/The New Mexican

The department does not necessarily have to abide by recommendations of the Benefit Package, Eligibility Verification and Recipient Cost-Sharing Cost-Containment Subcommittee. The department appointed the subcommittee after the Legislature passed and Gov. Susana Martinez signed into law a budget bill that directed the department to plug an $87 million shortfall in state funding for Medicaid — which translates into a potential $417 million cut in services due to federal matching money.

Medicaid, also known as Centennial Care, is a state-federal program that provides health insurance to children, the disabled and poor adults. It currently provides primary and emergency care as well as behavioral health services to 766,000 people in the state.

But the number of those who qualify for the program has risen under the Affordable Care Act, which now allows states to bring low-income adults into Medicaid. And those costs are rising faster than the state budget.
In trying to limit the cost increases, the state is moving forward with another set of proposals that would trim reimbursements for many services to doctors, specialists, dentists, therapists and hospitals. Those changes are awaiting approval from the federal government and expected to go into effect July 1.

The subcommittee looking at copays and premiums included those from the health care industry as well as advocates for the poor. Larry Martinez, the regional director for Presbyterian Medical Services, drafted the motion to impose premiums on enrollees.

Ruth Hoffman, director of the Lutheran Advocacy Ministry of New Mexico, voted against the proposal. She said the department should make a report to the Legislature about how it’s responding to the budget language directing it to make cuts to Medicaid.

“We all know this is not going to generate much money at all,” Hoffman said.

Sandy Potter, a vice president for Blue Cross Blue Shield, one of the four insurance companies that oversees Medicaid, agreed. “I just think it’s not going to make a hill of beans,” she said.

Joe Martinez, consumer outreach coordinator for Health Action New Mexico, told panel members they should vote down the motion because New Mexicans newly enrolled in Medicaid are just beginning to understand its benefits.
“Then to impose premiums and cost-sharing, it’s nothing more than making it more difficult and getting another pattern of denial” from the department, he said.

Members also voted down 5-4 a proposal to impose copays on Medicaid enrollees who use hospital emergency rooms for nonemergency care.

Erik Lujan, a subcommittee member with the All Pueblo Council of Governors, said that tribal members often go to the emergency room because it’s difficult to see a specialist on the spot.

Subcommittee members voted in favor of making a recommendation to the department that it impose copays on members purchasing more expensive brand-name drugs as opposed to the cheaper generics.

Nancy Smith-Leslie, Medicaid director for the Human Services Department, told the panel that Medicaid members currently use about 80 percent generic and 20 percent brand-name drugs.

Potter, of Blue Cross Blue Shield, made the proposal. She said other state Medicaid programs have higher rates of generic drug use.

“There’s an enormous opportunity to reduce costs,” Potter said.

Abuko Estrada, staff attorney for the New Mexico Center on Law and Poverty, urged the panel to vote against the recommendation because of a lack of data about its impact. He said the department should look for other ways to find Medicaid savings beyond cutting the benefits package.